[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) › Cefotetan # Cefotetan ## Beta-lactams? Beta-lactams Injectable second-generation cephamycin that also covers anaerobes such as Bacteroides fragilis; used for surgical prophylaxis and pelvic infections. Updated Nov 1, 2026 Also called: cefotetan disodium ## Quick facts **Group** [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) **Target** Penicillin-binding proteins (bacterial transpeptidases) **Used for** Gynaecological infections · Urinary tract infections **Key effects** Diarrhoea and nausea · Pain · Rash and itching **Monitor** Prothrombin time · Blood count and signs of haemolysis **ATC** J01DC05 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ✂**Penicillin-binding proteins (bacterial transpeptidases)**Cefotetan ⓘ No structure of cefotetan bound to a PBP is published; the figure shows cefoxitin, another cephamycin with the same 7-alpha-methoxy group, acylating E. coli PBP5. **Target in 3D:** Penicillin-binding proteins (bacterial transpeptidases). PDB structure 3MZE (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3MZE) · Drag to rotate · pinch to zoom Cefotetan acylates the penicillin-binding proteins and stops peptidoglycan cross-linking, so the bacterium lyses. Its 7-alpha-methoxy group (typical of cephamycins) protects it from many beta-lactamases and gives it activity against gut anaerobes such as B. fragilis as well as Enterobacterales. - The 7-alpha-methoxy group resists many beta-lactamases - Acylates the PBPs of the bacterial wall - Peptidoglycan cross-linking stops - The bacterium lyses (bactericidal) ## Indications - Gynaecological infections, including pelvic inflammatory disease in combination regimens [Pelvic inflammatory disease →](https://durgical.com/en/conditions/pelvic-inflammatory-disease/) - Intra-abdominal infections involving anaerobes [Intra-abdominal abscess →](https://durgical.com/en/conditions/intra-abdominal-abscess/) - Urinary tract infections by susceptible bacteria [Urinary tract infection (acute cystitis) →](https://durgical.com/en/conditions/urinary-tract-infection/) - Skin, soft-tissue, bone, joint and lower respiratory tract infections - Prophylaxis before clean-contaminated or contaminated surgery (for example colorectal or gynaecological) ## Adverse effects ### Common - Diarrhoea and nausea - Pain, redness or phlebitis at the injection site - Rash and itching - Eosinophilia and transient rise in liver enzymes ### Serious (rare, important) - Immune haemolytic anaemia, more frequent than with other cephalosporins; fatal cases are reported - Hypoprothrombinaemia and bleeding, above all with vitamin K deficiency or anticoagulants - Clostridioides difficile diarrhoea, from mild to fatal colitis - Anaphylaxis; cross-reactivity possible in people allergic to penicillin ## Contraindications - Allergy to cephalosporins - History of cephalosporin-associated haemolytic anaemia ## Key interactions **Alcohol** Disulfiram-like reaction (flushing, sweating, headache, tachycardia) during treatment and up to 72 hours after the last dose. **Aminoglycosides** Nephrotoxicity may increase; kidney function is watched and the two are not mixed in the same solution. **Copper-reduction urine glucose tests** False positives; enzymatic (glucose oxidase) methods are used instead. ## What is monitored - Prothrombin time, above all in malnourished people, liver disease or anticoagulation - Blood count and signs of haemolysis (pallor, dark urine, jaundice) - Kidney function when combined with an aminoglycoside ## Administration and safety - IV or IM; the powder is reconstituted following the product instructions - Not mixed in the same solution with aminoglycosides - Name looks like cefoxitin, cefotaxime and ceftazidime: the label is checked before giving it ## Pregnancy and breastfeeding Animal studies showed no fetal harm, but adequate human studies are lacking; it is used only when clearly needed. ## Nursing care - Ask about penicillin and cephalosporin allergy before the first dose - Explain that alcohol is avoided during treatment and for three days afterwards - Watch for bleeding, pallor, dark urine or jaundice - Watch for watery or bloody diarrhoea, even weeks later - Warn that it may lower the effect of hormonal contraceptives ## Pharmacokinetics **Absorption** Not absorbed by mouth; given IV or IM. **Elimination** Mainly renal: 51% to 81% leaves unchanged in the urine within 24 hours; removed by haemodialysis. **Half-life** 3 to 4.6 hours; longer when kidney function falls. ## Memory aid «TETan, TETrazole»: cefoTETan carries a thiotetrazole ring that brings two problems, a disulfiram reaction with alcohol and bleeding from low prothrombin. ## Test yourself Think of the answer, then tap the question to see it. ## Which chemical group lets cefotetan resist many beta-lactamases and cover B. fragilis? The 7-alpha-methoxy group of the cephamycins, the same one cefoxitin has. ## A patient has flushing, sweating and tachycardia after drinking alcohol two days after cefotetan. What happened? A disulfiram-like reaction, linked to cefotetan's thiotetrazole group; it can appear up to 72 hours after the dose. ## Which clotting test is watched with cefotetan, and why? The prothrombin time, because cefotetan can cause hypoprothrombinaemia and bleeding, above all with vitamin K deficiency. ## Which serious blood reaction is more frequent with cefotetan than with other cephalosporins? Immune haemolytic anaemia, which can be fatal; a history of it is a contraindication. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/cefotetan/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## Connections ## Related drugs 3 - [Cefoxitin](https://durgical.com/en/pharmacology/cefoxitin/) - [Cefuroxime](https://durgical.com/en/pharmacology/cefuroxime/) - [Cefazolin](https://durgical.com/en/pharmacology/cefazolin/) ## Related conditions 3 - [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/) - [Intra-abdominal abscess](https://durgical.com/en/conditions/intra-abdominal-abscess/) - [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/) [← Back to the class: Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - CEFOTETAN injection, powder, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33b13b93-58ce-44c7-b9a2-af3b3a333f80) (DailyMed (U.S. National Library of Medicine), 2026); [Cefotetan Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a686015.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Structure of penicillin-binding protein 5 from E.coli: cefoxitin acyl-enzyme complex](https://www.rcsb.org/structure/3MZE) (RCSB Protein Data Bank, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/cefotetan/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/cefotetan/